In 1973, Nichols and colleagues demonstrated that the addition of preoperative oral antibiotic bowel preparation (OABP) to the mechanical bowel preparation (MBP) was associated with a lower risk of wound infection after colorectal surgery. Since then, evidence for different methods of preoperative bowel preparation on postoperative outcomes, especially SSIs, anastomotic leak, postoperative ileus, sepsis, readmission, reoperation, mortality and length of hospital stay, has been equivocal.
Existing reports have evaluated the use of MBP and OABP, alone or in combination, relative to no bowel preparation, with limited data comparing the utility of each component of bowel preparation. A 2011 Cochrane review comparing MBP with no bowel preparation found no significant difference in the primary outcome of anastomotic leak, and no significant difference in the secondary outcomes of mortality, peritonitis, reoperation, wound infection and infectious extra‐abdominal complications. Recent randomized controlled trials, have similarly demonstrated that MBP alone does not improve postoperative outcomes. In contrast, recent studies, including RCTs and meta‐analyses, have demonstrated a clear reduction in SSI with MBP plus OABP compared with no bowel preparation.
In this lecture, professor Joseph S. Solomkin reviews the current results regarding the mechanical bowel preparation and surgical site infection, and gives some final recommendations on this controversial topic.